腹腔镜技术在腹部外科疾病中的应用研究

Application Research of Laparoscopic Technology in Abdominal Surgery

目的:探讨提拉牵引、结扎、电凝技术及自制纱布块在腹腔镜腹部外科疾病手术中的应用效果。方法:对1871例腹腔镜手术病人进行总结。其中胆囊切除1800例,术中观察胆囊动脉88%以上分支进入胆囊壁,分支有长有短,紧靠胆囊壁分支细小,可直接电凝切断。选择其中980例,采用提拉牵引法显露胆囊三角,电凝切断胆囊动脉分支,4号丝线结扎胆囊管,三孔法完成胆囊切除,未用钛夹。在56例肝、肾囊肿腹腔镜开窗引流手术中先在囊腔内预置纱布块,将碘酊注其上擦拭囊壁,擦拭完毕吸净纱布内碘酒后取出。在15例结、直肠癌根治手术中采用自制带不透X光兰色线条的纱布块,进行擦血、止血,协助显露术野。结果:1036例病人全部手术成功,无严重并发症发生。结论:胆囊分支细小可完全用电凝切断,提拉牵引法可有效显露胆囊三角,胆囊管通过结扎切断,不用钛夹,三孔法可安全完成腹腔镜胆囊切除。在肝、肾囊肿及结、直肠癌腹腔镜手术中采用自制纱布块,可有效减少腹腔污染,是擦血、止血的有效工具,并有助于显露术野。

Objective： To evaluate the application effects of traction, ligation, electric coagulation and self - made gauze for abdominal surgery by laparoscopy. Method： To summarize 1871 cases with laparoscopie operation. 1800 with laparoscopie eholecysteetomy, about 88% cystic artery branch come into gallbladder wall, which is thin enough can be cut by direct electric coagulation. To chose 980 cases with three holes laparoscopic cholecystectomy by traction to expose the calot＇s triangle, electric coagulation to cut the cystic artery and silk thread instead of titanium clip to ligate cystic duct. 56 cases of liver,renal cyst with laparoscopic fenestration, First, put the gaze into cyst. Then, perfuse iodine tincture on it and use the gauze to wipe the cyst wall. Finally, suction iodine tincture from the gauze and take it out. 15 cases with laparoscopic radical operation for colorectal cancer, self - made gauzes were used to wiping off blood, hemostasis and to assist to expose the field of operation. Result： 1036 cases were operated successful, none severe complication. Conelusion： The cystic artery can be cut by electric coagulation, tract the gallbladder can effectively expose the calot＇s triangle, and use silk thread instead of titanium clip to ligate cystic duct and three- hole method can safely achieve laparoscopic cholecystectomy. To use the self- made gauze in laparoscopic fenestration for liver,renal cyst and laparoscopic radical operation for colorectal cancer, can effectively reduce intra- abdominal sepsis, it is also an effective implement in wiping off blood, hemostasis and is assisted to expose the field of operation.